Medical advice please – rowing good/bad for the knees?

[david.h...@aea.be]

Dear all,
Haven't looked in here for quite a while. Good to see all is going well and several of my mates are still around.

My knees, which are approaching retirement age (like the rest of me) are well and truly crocked and have been for a few years now. The latest x-rays show substantial arthrosis and precious little cartilage left. I can’t stand up without assistance from my arms, I can’t squat down and walking downstairs or downhill isn’t particularly comfortable. However, I can row and erg without problems (getting in and out of the boat is a different matter).

I had a knee operation about seven years ago when a localised area of arthrosis was giving me particular bother. My surgeon, who was an ex-rower himself, was insistent that I should continue rowing after convalescence – along with cycling and swimming it was ‘the’ sport for dodgy knees. No exercise and weight gain being the worst thing. So I’ve been rowing/erging and a bit of cycling three times a week. Even picked up a couple of national erg age-category titles 4-5 years ago.

This time around, my consultant has told me to stop rowing. He says it might even have been responsible for the cartilage loss. According to him, I shouldn’t load my knees at angles greater than 45 degrees.

So my options are (a) ignore him, (b) seek a second opinion - I'm not sure if I can contact my previous doc, (c) somehow obtain a Thames skiff, (d) develop an erging style with a very short slide movement, (e) hit the bottle.

Does anyone have any practical expertise in this area?

Cheers, Dave H
Royal S.N. de Bruxelles

[John Greenly]

On Monday, August 19, 2013 10:10:14 AM UTC-4, david.h...@aea.be wrote:
> Dear all, Haven't looked in here for quite a while. Good to see all is going well and several of my mates are still around. My knees, which are approaching retirement age (like the rest of me) are well and truly crocked and have been for a few years now. The latest x-rays show substantial arthrosis and precious little cartilage left. I can’t stand up without assistance from my arms, I can’t squat down and walking downstairs or downhill isn’t particularly comfortable. However, I can row and erg without problems (getting in and out of the boat is a different matter). I had a knee operation about seven years ago when a localised area of arthrosis was giving me particular bother. My surgeon, who was an ex-rower himself, was insistent that I should continue rowing after convalescence – along with cycling and swimming it was ‘the’ sport for dodgy knees. No exercise and weight gain being the worst thing. So I’ve been rowing/erging and a bit of cycling three times a week. Even picked up a couple of national erg age-category titles 4-5 years ago. This time around, my consultant has told me to stop rowing. He says it might even have been responsible for the cartilage loss. According to him, I shouldn’t load my knees at angles greater than 45 degrees. So my options are (a) ignore him, (b) seek a second opinion - I'm not sure if I can contact my previous doc, (c) somehow obtain a Thames skiff, (d) develop an erging style with a very short slide movement, (e) hit the bottle. Does anyone have any practical expertise in this area? Cheers, Dave H Royal S.N. de Bruxelles

Dave,

start with a disclaimer: I have no professional medical credentials at all. I can only tell you my personal experience.

I haven't brought this up on RSR before, but I started rowing because of knee problems. I have been battling rheumatoid arthritis since my early twenties, am now about to turn 65. I've had knee surgery six times over the years, and about ten years ago had gotten to a point where my legs were getting so weak that I was very prone to injury and walking on uneven surfaces was becoming a danger. I couldn't do any weight-bearing exercise, and my knees couldn't handle bicycling. I discovered rowing at a place we rented for a week in Maine that had, among other boats, a handsome whitehall-type hull with a sliding-seat rig. I quickly discovered with that rig that I could gently use my legs (and all my joints) through their whole range of motion, and as long as I was very careful not to overstress them, my knees did all right. I made contact with some scullers when I got home, and have been sculling ever since, first in a stable open boat, then in an open-water shell and finally this year in a racing single. My legs still are not strong, but are MUCH stronger than they were, and my knees can stand much more strain than before. I can push hard and they don't blow up the way they used to. I have significantly more range of motion now (almost 110 degrees bend) than when I started, though I will always be limited in compression at the catch. Some of this improvement has to do with dietary and other changes that have helped the arthritis, but I am sure that a lot of it is directly the result of the excellent, smooth, full range of motion exercise of sculling.

I had a bit of minor knee surgery done this May to get rid of a bone spur that was aggravating a ligament, and my long-time surgeon said that my knee looked surprisingly good. It has had very little cartilage for 30 years, and he has been telling me for 20 years that I am a good candidate for knee replacement, but I'd rather keep my own knees for as long as I can. He encouraged me to keep rowing, as the best possible exercise. He says it is good for circulation in the joints which helps nourish cartilage, it tends to reduce inflammation, and it strengthens the muscles and supporting structures that protect from injury. I think he takes some pride in hearing of my racing exploits (such as they are: finding the finish line successfully about sums it up).

I would say that sculling has done me a world of good in many ways and even if it did eventually end up hurting my knees I would do it for all the many physical and psychological benefits it gives me. I have an 85 year old sculler friend who had both knees replaced a few years ago, and he still gets out on the water several times a week- so if it comes to that, I know it can be done.

If I were you, I would go for option (b)-- get another opinion, by all means. I would be inclined to give up biking though- more strain on the knees and more cycles of compression per session of exercise. I tried getting on a bike a couple of years ago, and it took a month for my knees to recover.

very best wishes to you,

--John G

[sully]

Not personally, but a couple club members have really bad knees as well.
Rowing is about all they can do! The tricky parts are getting into the boat,
and carrying them, though.

And I agree with the angles, they row pretty short, 3/4 slide and their knees are quite fine.

[johnf...@gmail.com]

I have had mild problems with my right knee, ending up with surgery last year to clean up a slight meniscus issue. Both before and after surgery sculling seemed to benefit it. I too am trying to delay knee replacement as long as possible. One of our club members had to have a knee replacement and ended up with reduced range of motion in that knee, which has shortened his stroke. I was told by my knee doctor that replacement usually improves range of motion over what people had before the operation because generally deterioration reduces range of motion, but in this case he had fulll range before the operation and now has less.

I think it's a good strategy to delay replacement as long as possible in the hope that the technology of replacement joints will improve over time.

[david.h...@aea.be]

On Tuesday, August 20, 2013 2:13:54 PM UTC+2, johnf...@gmail.com wrote:
> I think it's a good strategy to delay replacement as long as possible in the hope that the technology of replacement joints will improve over time.

A surgeon clubmate of mine (not an orthopaedic surgeon, unfortunately, but well-informed) says that it is a good idea to delay replacement - because replacements typically last just ten years. He said it's an operation you really only want to have once.

My consultant advised against replacement because I am in no pain. A replacement he said would bring its own problems, possibly more than it would cure.

Re cycling - the advice I received last week is that cycling is absolutely fine, so long as the saddle is set as high as is practicable. My previous specialist also recommended cycling although steep climbs at high power were to be avoided, with which I was only too happy to concur. Belgium tends to be nice and flat anyway.

[johnf...@gmail.com]

Actually my right knee injury originated years ago from cycling with a seat that was just a trifle too high. I was using a fixed gear and high pedal rpms. Make sure your leg has a slight bend in it at the bottom of the pedal stroke to ensure that your knee cannot lock at that point.

[John Greenly]

On Tuesday, August 20, 2013 8:13:54 AM UTC-4, johnf...@gmail.com wrote:
> One of our club members had to have a knee replacement and ended up with reduced range of motion in that knee, which has shortened his stroke. I was told by my knee doctor that replacement usually improves range of motion over what people had before the operation because generally deterioration reduces range of motion, but in this case he had fulll range before the operation and now has less. I think it's a good strategy to delay replacement as long as possible in the hope that the technology of replacement joints will improve over time.

As to range of motion after joint replacement, I have been told by several authorities that it all depends on how well you are able to do the exercises and stretching that must be done starting right after the operation. The first couple of weeks are critical. I believe the joint hardware technology itself is not a limiting factor. It's the same for any major knee surgery, and from my own experiences I can tell you that it's very hard and painful work but absolutely necessary to prevent formation of scar tissue that permanently restricts motion.

--John G

[johnf...@gmail.com]

On Tuesday, August 20, 2013 11:53:44 AM UTC-4, John Greenly wrote:
> As to range of motion after joint replacement, I have been told by several authorities that it all depends on how well you are able to do the exercises and stretching that must be done starting right after the operation. The first couple of weeks are critical. I believe the joint hardware technology itself is not a limiting factor. It's the same for any major knee surgery, and from my own experiences I can tell you that it's very hard and painful work but absolutely necessary to prevent formation of scar tissue that permanently restricts motion.
>

I can promise you that the guy in question certainly did ALL the exercises despite the pain, etc. If anything, he may have gone BEYOND the recommended program. Which might have caused a problem, I don't know.

[lynnz...@gmail.com]

On Monday, August 19, 2013 10:10:14 AM UTC-4, david.h...@aea.be wrote:

> Dear all,
>
> Haven't looked in here for quite a while. Good to see all is going well and several of my mates are still around.
>
>
>
> My knees, which are approaching retirement age (like the rest of me) are well and truly crocked and have been for a few years now. The latest x-rays show substantial arthrosis and precious little cartilage left. I can't stand up without assistance from my arms, I can't squat down and walking downstairs or downhill isn't particularly comfortable. However, I can row and erg without problems (getting in and out of the boat is a different matter).
>
>
>

> I had a knee operation about seven years ago when a localised area of arthrosis was giving me particular bother. My surgeon, who was an ex-rower himself, was insistent that I should continue rowing after convalescence - along with cycling and swimming it was 'the' sport for dodgy knees. No exercise and weight gain being the worst thing. So I've been rowing/erging and a bit of cycling three times a week. Even picked up a couple of national erg age-category titles 4-5 years ago.

>
>
>
> This time around, my consultant has told me to stop rowing. He says it might even have been responsible for the cartilage loss. According to him, I shouldn't load my knees at angles greater than 45 degrees.
>
>
>
> So my options are (a) ignore him, (b) seek a second opinion - I'm not sure if I can contact my previous doc, (c) somehow obtain a Thames skiff, (d) develop an erging style with a very short slide movement, (e) hit the bottle.
>
>
>
> Does anyone have any practical expertise in this area?
>
>
>
> Cheers, Dave H
>
> Royal S.N. de Bruxelles

Dave - i also am not a doctor, but I would suggest a second opinion because the rowing motion is not weight bearing and provided you have the range of motion necessary, I don't think you are actually "loading" that knee. Have you tried a shot of synvisc? It is an injectable lubricant. I am trying it now, hoping to avoid partial or full knee replacement.

I am seeking tips on how to get into my single now that my arthritic right knee won't allow a deep weight-bearing squat. I don't have a problem on return because I can bend my left knee enough to lift my butt onto the dock. Any ideas would be gratefully received. Someone suggested turning the boat bow to stern and using my "good" left leg, but that won't work at my dock.

[James HS]

Not fully understanding, get in, left foot on deck, squat placing right foot down, getting out reverse, so if getting out is ok, can you describe more why getting in is not?

James

[Lucy]

Alternatively do what our AS Para girls do - sit on the dock, then transfer using your arms to lift your bum across. You may need someone to hold the boat steady while you do it, although I have done it by myself (I'm Para too, borderline LTA/TA, so when my legs go, they've gone!) by leaning my weight across the wing rigger to keep things steady, although admittedly there's a bit of a knack to it. If using a conventional rigger, do as I do in a similar scenario getting into a fine 2x, and trail your legs across the rigger to hold it down, then steady the boat with your hand while swinging your legs across.

Hope that makes some kind of sense?

[Lucy]

Ps. James, from the way I'm reading it, he's shuffling his bum out to get out, which is, indeed the precise opposite to the AS-style transfer I'm suggesting above.

[lzei...@spadealaw.com]

On Sunday, August 24, 2014 5:28:41 PM UTC-4, James HS wrote:
> Not fully understanding, get in, left foot on deck, squat placing right foot down, getting out reverse, so if getting out is ok, can you describe more why getting in is not?
>
>
>
> James

My left leg won't support my weight in a squat. Getting out is easier because (1) I can put some weight on the left leg on the centerboard and (2) I have no need to center my bottom on a seat getting out - just anywhere on the dock is okay. Getting in, on the other hand, I need to be centered on the seat and have no way to do that in a slide-on yet.

[sully]

Ah, I got it now. Like James I had trouble picturing.

The way I teach new scullers who are unable to get up/down in shell as you describe:
0. sit on dock next to shell, butt lined up with sternmost part of tracks.
1. outboard hand grasping both scull grips. blade edge down on dock, flat on water, lift up on handles to keep boat steady.
2 outboard foot on footboard tops, inboard foot in boat but keep knee over dock
3. slide toward boat such that weight is on dockside buttcheek, place dockside hand on edge of dock right behind, almost under butt.
4. push on dock hand to raise butt, a little pressure on offdock foot to help lift and slide the butt over to the seat. Depending on the arrangement of boat/dock, you might hook the thumb on the gunwhale of the dock hand you're pushing on. the docside knee can help elevate the butt a little.
5. Make one single action to get butt onto seat, then STOP. If you aren't square on the seat, pause for a minute and gather, do not scramble into the boat.

If you're halfway on boat and dock, scrambling will push the boat away from the dock, stop and regather.

A few of the ppl I've had like this managaged to row for a while, and while I steadied the boat for them and helped when they were learning, later they were able to get in without help.

[Brian Chapman]

Rowed at a Dutch club and they had a floating stage/dock with a slot for a boat in one end with an overhead bar to assist getting into and out of the boat.

[sully]

yes, was sketching out some ideas similar to this for when we build an adaptive dock, though hanging over the edge of dock, didn't think about a slot for the boat.

The other hack I'm playing with is a board that extends acros the boat from the dock, hooking on the outside gunwhale. Athlete sits on the board on the dock, shuffles out on the boat, the seat then abuts to the board, and you simply slide from board to seat.

[GeorgeH]

On Monday, August 19, 2013 10:10:14 AM UTC-4, david.h...@aea.be wrote:

> Dear all,
>
> Haven't looked in here for quite a while. Good to see all is going well and several of my mates are still around.
>
>
>
> My knees, which are approaching retirement age (like the rest of me) are well and truly crocked and have been for a few years now. The latest x-rays show substantial arthrosis and precious little cartilage left. I can't stand up without assistance from my arms, I can't squat down and walking downstairs or downhill isn't particularly comfortable. However, I can row and erg without problems (getting in and out of the boat is a different matter).
>
>
>

> I had a knee operation about seven years ago when a localised area of arthrosis was giving me particular bother. My surgeon, who was an ex-rower himself, was insistent that I should continue rowing after convalescence - along with cycling and swimming it was 'the' sport for dodgy knees. No exercise and weight gain being the worst thing. So I've been rowing/erging and a bit of cycling three times a week. Even picked up a couple of national erg age-category titles 4-5 years ago.

>
>
>
> This time around, my consultant has told me to stop rowing. He says it might even have been responsible for the cartilage loss. According to him, I shouldn't load my knees at angles greater than 45 degrees.
>
>
>
> So my options are (a) ignore him, (b) seek a second opinion - I'm not sure if I can contact my previous doc, (c) somehow obtain a Thames skiff, (d) develop an erging style with a very short slide movement, (e) hit the bottle.
>
>
>
> Does anyone have any practical expertise in this area?
>
>
>
> Cheers, Dave H
>
> Royal S.N. de Bruxelles

I'm with lynnz on Synvisc and Hyalgan,the two competing brands of knee lubricant/shock absorber fluid. After three arthroscopic surgeries on my knees (two on the right, one on the left), my surgeon said there was no point in doing any more. I was in pain, and it was limiting my cycling and sculling (and walking and everything else). The surgeon and I started talking knee replacements, and I began calling rowers who'd had them (to a person, they said they could still row fine, and wished they hadn't waited so long to do the operation).

But as a last-ditch substitute, the surgeon suggested I try Synvisc, so I got three injections, one a week in each knee. There was no immediate relief, but a few weeks later I realized I wasn't in pain the way I had been, and could do much more without discomfort.

That was roughly 15 years ago. Since then I've gone through about six or seven treatments, and they have all had the same effect: No dramatic, amazing change right away, but a slow, significant reduction in discomfort that allows me to walk/row/cycle/etc. with much less pain than before.

The treatments are supposed to last about six months to two years, and I tend to be on the long side. I liked Synvisc, but on my second go, I had an allergic reaction that caused a knee to blow up. The surgeon switched me to Hyalgan, which requires five weekly injections instead of three. I've been fine ever since. To me, they both seem the same. And by the way, the surgeon tells me a key ingredient is rooster combs. Sounds like quackery, I know -- but for me at least, it works amazingly well.

I'm always shocked in comparing notes with fellow knee-pain sufferers how few have ever even heard of this stuff. It's not to be confused with cortisone or other pain-killers -- like I said, it seems to be a combination lubricant and shock absorber that gets injected directly into your knee capsule to sort of float and lubricate your joint. Or that's more or less how it's been explained to me. And after awhile, you need to top it up -- I assume it leaks away or gets absorbed over time.

The injections aren't pain-free, but they're not awful. Totally worth it, in my view. I don't fear getting a knee replacement (I'm getting a new hip next month, and can't wait). But I agree that putting it off makes sense, since if you live long enough, you're likely to need a second one, and I hear they're a little more complicated.

[Lucy]

That sounds like a fabulous idea, Sully. Any chance of sharing how you get on? We're quite a dedicated Para club up here at Tees, and the more we can share ideas the better!

[sully]

On Friday, August 29, 2014 2:41:22 PM UTC-7, Lucy wrote:
> That sounds like a fabulous idea, Sully. Any chance of sharing how you get on? We're quite a dedicated Para club up here at Tees, and the more we can share ideas the better!

Lucy

Hope you're still reading RSR! I haven't done any work on that yet, but you might be interested in this:
https://www.facebook.com/sulsness/media_set?set=a.10203475317590717.1073741828.1446715508&type=1

I've mounted pontoons on a surfski and on a flatwater kayak (K-1) as well as seats to support adaptive people.

My thesis is that athletes in wheelchairs will be much closer in speed to legged athletes in racing kayaks than they will in rowing shells. The problem is that the learning curve in a racing kayak is enormous, a lot of tipping over, not very enticing for athletes with limited mobility.

Thus the pontoons that can be adjusted up as they gain the paddling skills and be there as a safety measure.

I had two old destroyed boats that I rebuilt for testing. The surfski is way too heavy, though it motors along fine. It's a good learning boat and much more responsive and quick than the average recreational floaty boats. the K-1 is lightning!

[Lucy]

That's fabulous! I'm a Legs, Trunks and Arms rower at the minute, but am expecting a re-classification to Trunks and Arms very soon....Wonder if I could get away with kayaking as well as rowing? It certainly looks like a really well thought out prototype - do let me know how it works out in practice, please - even as an LTA my balance is shot (I have MS), so it could well help people liek me as well!

[sully]

On Friday, September 12, 2014 2:15:53 PM UTC-7, Lucy wrote:
> That's fabulous! I'm a Legs, Trunks and Arms rower at the minute, but am expecting a re-classification to Trunks and Arms very soon....Wonder if I could get away with kayaking as well as rowing? It certainly looks like a really well thought out prototype - do let me know how it works out in practice, please - even as an LTA my balance is shot (I have MS), so it could well help people liek me as well!
>

What I'm trying to figure out is how to make the sprint kayaks accessible. There are a lot of rec kayaks out there that are useful and fun for adaptive paddling. The sprint kayaks are fast, and for athletes that want to train and race, I think it's a great choice.

We're an ocean away, I'm in California. I've got a plan to construct several more pontoon frames as inexpensively and effectively as I can, and still working on a seat concept that works better than the one I have. But I have a couple other projects in the way, including the one handed sculling rig.

I have access to a number of old K-1s and K-2, so that's no issue.

If you can find a K-1 and want to build an adaption yourself, I'll share what I've done so far, it's not a difficult construction.

[Lucy]

Sadly I've no access to nor knowledge of kayaks, so I shall just have to content myself with watching your progress from afar.. Do keep us "in the loop", won't you? You never know what may end up being transferrable between the two sports.

On Monday, August 19, 2013 3:10:14 PM UTC+1, david.h...@aea.be wrote:
> Dear all,
>
> Haven't looked in here for quite a while. Good to see all is going well and several of my mates are still around.
>
>
>
> My knees, which are approaching retirement age (like the rest of me) are well and truly crocked and have been for a few years now. The latest x-rays show substantial arthrosis and precious little cartilage left. I can't stand up without assistance from my arms, I can't squat down and walking downstairs or downhill isn't particularly comfortable. However, I can row and erg without problems (getting in and out of the boat is a different matter).
>
>
>

> I had a knee operation about seven years ago when a localised area of arthrosis was giving me particular bother. My surgeon, who was an ex-rower himself, was insistent that I should continue rowing after convalescence - along with cycling and swimming it was 'the' sport for dodgy knees. No exercise and weight gain being the worst thing. So I've been rowing/erging and a bit of cycling three times a week. Even picked up a couple of national erg age-category titles 4-5 years ago.